Systemic arterial pulsatility index (SAPi) predicts adverse outcomes in advanced heart failure patients.
Sula MazimbaHunter MwansaKhadijah BreathettJarred E StricklingKajal ShahColeen McNamaraNishaki MehtaYounghoon KwonJosephine LampLu FengJose TallajSalpy PamboukianMwenya MubangaJashanjeet MatharooScott LimMichael SalernoVictor MwansaKenneth C BilchickPublished in: Heart and vessels (2022)
Ventriculo-arterial (VA) coupling has been shown to have physiologic importance in heart failure (HF). We hypothesized that the systemic arterial pulsatility index (SAPi), a measure that integrates pulse pressure and a proxy for left ventricular end-diastolic pressure, would be associated with adverse outcomes in advanced HF. We evaluated the SAPi ([systemic systolic blood pressure-systemic diastolic blood pressure]/pulmonary artery wedge pressure) obtained from the final hemodynamic measurement in patients randomized to therapy guided by a pulmonary arterial catheter (PAC) and with complete data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Cox proportional hazards regression was performed for the outcomes of (a) death, transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and (b) DTxLVAD. Among 142 patients (mean age 56.8 ± 13.3 years, 30.3% female), the median SAPi was 2.57 (IQR 1.63-3.45). Increasing SAPi was associated with significant reductions in DTxLVAD (HR 0.60 per unit increase in SAPi, 95% CI 0.44-0.84) and DTxLVADHF (HR 0.81 per unit increase, 95% CI 0.70-0.95). Patients with a SAPi ≤ 2.57 had a marked increase in both outcomes, including more than twice the risk of DTxLVAD (HR 2.19, 95% CI 1.11-4.30) over 6 months. Among advanced heart failure patients with invasive hemodynamic monitoring in the ESCAPE trial, SAPi was strongly associated with adverse clinical outcomes. These findings support further investigation of the SAPi to guide treatment and prognosis in HF undergoing invasive hemodynamic monitoring.
Keyphrases
- pulmonary artery
- blood pressure
- left ventricular
- heart failure
- pulmonary hypertension
- coronary artery
- ejection fraction
- acute heart failure
- pulmonary arterial hypertension
- cardiac resynchronization therapy
- phase iii
- heart rate
- phase ii
- hypertensive patients
- clinical trial
- aortic stenosis
- left ventricular assist device
- acute myocardial infarction
- hypertrophic cardiomyopathy
- randomized controlled trial
- systematic review
- double blind
- study protocol
- mitral valve
- end stage renal disease
- stem cells
- left atrial
- mesenchymal stem cells
- cell therapy
- peritoneal dialysis
- coronary artery disease
- percutaneous coronary intervention
- deep learning
- aortic valve
- placebo controlled
- prognostic factors
- bone marrow
- weight loss